An innovative surgical treatment method in persistent rectal prolapse: Ventral abdomino-rectosigmoidopexy through tube sigmoidostomy combined with Ekehorn's rectopexy.

OBJECTIVE: Herein, the results of the cases, who underwent surgical repair with or without ventral abdomino-rectosigmoidopexy through tube sigmoidostomy combined with Ekehorn's rectopexy due to recurrent rectal prolapse, were discussed. METHODS: The demographic characteristics, surgical technique, and results of children who were operated in the department of Pediatric Surgery for rectal prolapse between 2004 and 2022 were retrospectively analyzed. RESULTS: In 18 years, six pediatric cases (2 females [33%] and 4 males [67%]) were operated for persistent rectal prolapse. The mean operative age of the patients was 7.5 years (2.1-17), and all had severe rectal prolapse. Some of these patients were followed up in other centers and their rectal prolapse continued despite diet changes, toilet behavior training, and the treatment of sclerosing agents. Rectal trimming was applied to one of the first two patients who were operated for anal atresia and recurrence did not occur. In the second case who underwent laparoscopic colon pull-through, Ekehorn rectopexy was performed alone and no recurrence was observed also in this case. Considering that rectosigmoid colon adhesions formed on the anterior abdominal wall due to colostomy opening-closing may provide ventral sigmoidopexy, it was decided to offer the option of applying both methods together. Three of the next four cases were diagnosed with cystic fibrosis. All four underwent ventral abdomino-rectosigmoidopexy through tube sigmoidostomy combined with Ekehorn's rectopexy. Ekehorn's butterfly sutures were removed on 15th day and Foley catheters on 21st day. Three cases with cystic fibrosis were uneventful. However, a 14-year-old girl with a history of sexual abuse relapsed 6 months later. CONCLUSION: Ventral abdomino-rectosigmoidopexy through tube sigmoidostomy combined with Ekehorn's rectopexy is a successful and unique method in terms of providing intestinal fixation. It may be the primary option for definitive surgical treatment of persistent rectal prolapse.

Does total knee arthroplasty affect pelvic movements? A prospective comparative study.

OBJECTIVE: Pathology in any segment of the spine-pelvis-lower extremity may impair the global postural balance, leading to compensatory alterations in other parts. The aim of this study was to compare the pelvic movements of patients suffering from knee osteoarthritis with patients who underwent total knee arthroplasty and healthy controls. METHODS: This study was performed at the Department of Orthopedics and Traumatology Clinic of a Cankiri State Hospital between April 2021 and February 2022. This study included 84 participants. Of them, 31 patients who underwent total knee arthroplasty between 2018 and 2020 years were selected as the total knee arthroplasty group, while 28 patients with knee osteoarthritis were selected as the knee osteoarthritis group. In the control group, there were 25 healthy individuals. Exclusion criteria from the study included any kind of neurological disease, an inability to walk a distance of 100 m unassisted, or a history of surgery to the lower limb. Pelvic movements (i.e., tilt, rotation, and obliquity) and gait parameters (i.e., "gait velocity," "cadence," and "stride length") were assessed using a wireless tri-axial accelerometer. RESULTS: Total knee arthroplasty and control groups had decreased minimum anterior tilt of the pelvis, decreased maximum anterior tilt, and decreased oblique range of the pelvis compared with the knee osteoarthritis group. In comparison with the control group, gait velocity and length of stride during gait were remarkably lower in both knee osteoarthritis and total knee arthroplasty groups. CONCLUSION: In this study, total knee arthroplasty was found to affect pelvic movements. It was thought that total knee arthroplasty changed these variables, probably owing to the frontal and sagittal plane alignment correction through surgery.

Does total knee arthroplasty affect pelvic movements? A prospective comparative study

SUMMARY OBJECTIVE: Pathology in any segment of the spine-pelvis-lower extremity may impair the global postural balance, leading to compensatory alterations in other parts. The aim of this study was to compare the pelvic movements of patients suffering from knee osteoarthritis with patients who underwent total knee arthroplasty and healthy controls. METHODS: This study was performed at the Department of Orthopedics and Traumatology Clinic of a Cankiri State Hospital between April 2021 and February 2022. This study included 84 participants. Of them, 31 patients who underwent total knee arthroplasty between 2018 and 2020 years were selected as the total knee arthroplasty group, while 28 patients with knee osteoarthritis were selected as the knee osteoarthritis group. In the control group, there were 25 healthy individuals. Exclusion criteria from the study included any kind of neurological disease, an inability to walk a distance of 100 m unassisted, or a history of surgery to the lower limb. Pelvic movements (i.e., tilt, rotation, and obliquity) and gait parameters (i.e., "gait velocity," "cadence," and "stride length") were assessed using a wireless tri-axial accelerometer. RESULTS: Total knee arthroplasty and control groups had decreased minimum anterior tilt of the pelvis, decreased maximum anterior tilt, and decreased oblique range of the pelvis compared with the knee osteoarthritis group. In comparison with the control group, gait velocity and length of stride during gait were remarkably lower in both knee osteoarthritis and total knee arthroplasty groups. CONCLUSION: In this study, total knee arthroplasty was found to affect pelvic movements. It was thought that total knee arthroplasty changed these variables, probably owing to the frontal and sagittal plane alignment correction through surgery.

The evaluation of radiological measurements used in diagnosis and treatment of syndesmosis injury: A regional study in Turkey.

OBJECTIVES: This study aims to improve the diagnostic reliability of syndesmosis injuries through evaluation of radiological measurements in the Turkish population and to provide mean reference values to prevent malreduction and overcompression during the treatment. PATIENTS AND METHODS: This retrospective study was performed between January 2018 and May 2018. The bilateral anteroposterior (AP) and lateral radiographs of 100 patients (60 males, 40 females; mean age 42.9 years; range, 23 to 72 years) who presented at our polyclinic were analyzed. Tibiofibular overlap (TFO), tibiofibular clear space (TFCS) and medial clear space (MCS) measurements were performed on the AP radiographs. The lateral radiographs were evaluated in respect of the anterior tibiofibular interval (ATFI), posterior tibiofibular interval (PTFI), and anterior tibiofibular ratio (ATFR) for syndesmosis reduction assessment. The lower and upper limits, mean and median values of the measurements were recorded. RESULTS: The measurements on the AP radiographs were determined to be as TFO: 7.9±2.4 mm (4-13), TFCS: 3.8±0.9 mm (2.2-6), MCS: 3.3±0.4 mm (2.7-4.5), and superior clear space: 3.3±0.3 mm (2.7-3.8). According to the measurements on the AP radiographs, the TFCS did not show any difference in terms of the variables of age, gender and side (p=0.070, p=0.219 and p=1.0, respectively). These measurements on the AP radiographs showed a high statistical consistency in terms of side (p=0.72, p=1.0, p=0.900 and p=0.920, respectively). The measurements on the lateral radiographs were as ATFI: 12.8±2.4 mm (8-18), PTFI: 6.1±2.9 mm (3-15) and ATFR: 0.4±0.1 (0.28-0.5). According to the measurements on the lateral radiographs, the ATFR did not show any difference in terms of the variables of age, gender and side (p=0.750, p=0.570 and p=0.848, respectively). The lateral measurements indicated statistical consistency in terms of side (p=0.400, p=0.260 and p=0.848, respectively). CONCLUSION: On the AP radiographs, TFCS was found to be reliable and the intraoperative evaluation of its high consistency with the opposite extremity is appropriate to avoid overcompression. The evaluation of ATFR on lateral radiographs was found to be reliable and evaluation is recommended to avoid intraoperative malreduction.

An evaluation of the effect on lower extremity fracture healing of collagen-based fusion material containing 2 different calcium phosphate salts: An experimental rat model.

BACKGROUND: Collagen-based synthetic bone grafts which contain tricalcium phosphate (TCP) and hydroxyapatite (HA), and collagen-based synthetic bone grafts containing only TCP have some advantages compared to autografts. Therefore, these grafts are frequently used to fill bone defects and pseudoarthrosis. OBJECTIVES: The aim of this study was to evaluate and compare the clinical, radiological and histopathological effects of TCP-HA and TCP alone + Type-1 collagen in healing lower extremity fractures in a pseudoarthrosis model in rat femurs. MATERIAL AND METHODS: A total of 36 female Wistar rats were randomly separated into 4 groups. Group 1 (n = 10) was the control group. A femur pseudoarthrosis model was created in Groups 2, 3 and 4. On the 90th day after the 1st surgery in Group 2 (n = 10), TCP-HA + Type-1 collagen was applied, in Group 3 (n = 10), TCP alone + type-1 collagen was applied, and in Group 4 (n = 6, the placebo group), saline solution was applied. Fixation was performed with an intramedullar pin. After 60 days and clinical and radiological scoring, all animals were sacrificed and a histopathological evaluation of the pseudoarthrosis areas was conducted. RESULTS: In all the clinical, radiological and histopathological measurements used in the evaluations of the differences between the groups, a higher rate of union was determined in Group 2 (TCP-HA). No significant difference was determined between Group 3 and Group 4 in terms of union rates. CONCLUSIONS: The clinical, radiological and histopathological results of this study showed that TCP alone was less effective than TCP-HA in the union of a femur pseudoarthrosis model in rats. The reason for this difference was considered to be hydroxyapatite (HA).

Comparison of aerobic conjunctival bacterial flora in pregnant, reproductive-aged and postmenopausal women.

AIM: To evaluate the effect of hormonal status on aerobic conjunctival flora in women. METHODS: One hundred fifty-eight women [reproductive-aged (n=55), pregnant (n=51), and postmenopausal (n=52)] who admitted to outpatient clinic of Obstetrics and Gynecology Department of Denizli State Hospital were enrolled. Age, body-mass index (BMI), obstetric history, cigarette smoking, drug usage, presence of systemic disease, and intraocular pressure (IOP) were recorded for each patient. The samples were taken from the lower fornix with two culture swabs and directly incubated in culture containing 5% sheep blood, eosin-methylene blue and chocolate agar. The other swab specimen was Gram stained. All growths and microscopic results were analyzed. RESULTS: The coagulase-negative Staphylococcus was the predominant organism isolated in the conjunctival samples in both three groups. The aerobic microorganism growth rate for all isolated aerobic organisms revealed no significant change in the three groups (P >0.05). The conjunctival culture positivity rates were similar in the three groups (49% in reproductive-aged, 57% in pregnant and 58% in postmenopausal women) (P >0.05). Age, IOP, BMI, gravidity, parity, cigarette smoking, drug usage, and presence of systemic diseases did not have an effect on culture positivity in three groups. CONCLUSION: Results of this study showed that conjunctival aerobic flora and bacterial colonization did not differ between reproductive-aged, pregnant and postmenopausal women.

Relation between 3435C>T multidrug resistance 1 gene polymorphism with high dose methylprednisolone treatment of childhood acute idiopathic thrombocytopenic purpura.

UNLABELLED: The current study was conducted to assess 3435C>T multidrug resistance 1 gene polymorphism and the efficacy of high dose methylprednisolone (HDMP) in childhood acute idiopathic thrombocytopenic purpura patients. METHODS: A total of 31 childhood acute Idiopathic thrombocytopenic purpura patients (17 females, 14 males) between the ages of 2 and 16 years of age were included in the study. High-dose methylprednisolone was given at a dose of 30mg/kg/day for 3 days and 20mg/kg/day for 4 days, consecutively and intravenously. Polymerase chain reaction-restriction fragment length polymorphism was used for the detection of C3435T single nucleotide polymorphism. Fragments obtained were 238bp to T/T genotype, 172bp and 60bp fragments to the C/C genotype, and 238bp, 172bp and 60bp to the C/T genotype. RESULTS: The distribution of CC, CT, and TT genotypes were 19.0%, 61.3%, and 19.4%, respectively. Both allele frequencies of C and T were the same - 50%. There was no significant difference in genotype and allele distribution between the patients with ITP and the control group (χ(2)=0.84 p=0.65, χ(2)=0.2 p=0.63, respectively). There were no significant differences in age, gender, and pre- and post-treatment platelet counts between CC, CT, and TT genotypes of the MDR gene. Response to treatment shows no significant difference between genotype and allele groups. CONCLUSION: In our study, there was no difference in the HDMP treatment response between MDR1 gene genotypes. However, it should be noted that this study includes a small group of patients. Our data should therefore be considered preliminary, awaiting further confirmatory studies on an expanded patient base.

Helicobacter pylori seropositivity in fibromyalgia syndrome.

Although there are some studies suggesting relation between different types of infection and fibromyalgia syndrome (FM), there is presently no proof that FM is caused by an infection. Helicobacter pylori (HP) infection may cause extragastric manifestations. Inflammation is an important mediator of increased sympathetic nervous system activity and may lead to pain in fibromyalgia patients. In this study, we aimed to investigate the HP seropositivity in fibromyalgia patients compared with controls for possible role of HP infection in FM. Sixty-seven patients with fibromyalgia were evaluated. Two of them were excluded from the study because of high level of acute phase reactants. Sixty-five female patients with fibromyalgia and 41 randomly selected age-matched female healthy controls were enrolled to study. Serum HP IgA and IgG antibodies were measured by enzyme-linked immunosorbent assay technique. Fibromyalgia Impact Questionnaire was assessed in patients and controls. Seropositivity of HP IgG antibody in the fibromyalgia patients was significantly higher than in the control group. No statistically significant differences were found regarding the clinical features between fibromyalgia patients with HP IgG antibody and patients without IgG antibody. Our study suggests that former HP infection may have a role in the etiopathogenesis of fibromyalgia syndrome or may act as a triggering factor. However, high seroprevalence of HP in general population and prevalent asymptomatic infection make it difficult to interpret these results for the definite role of HP in FM. Highlighting the pathophysiologic mechanisms of FM will result in more effective treatment regimens.

[The distribution of intestinal parasites among children in Denizli]. / Denizli'deki cocuklarda intestinal parazitlerin dagilimi.

Intestinal parasitic disease appears to be an important national health problem in our country. Parasitic infection distribution is related to the socioeconomic status and environmental factors. The aim of this study was to determine the distribution of intestinal parasites among children in the 1-15 age group in the Denizli province. Parasitic infection was observed in 256 (10.2%) out of 2518 children. The highest rate of 31.4% was that of Giardia intestinalis. The rates of Enterobius vermicularis and Blastocystis hominis were found to be 29.6% and 14% respectively.

[Investigation of Legionella pneumophila seropositivity in the professional long distance drivers as a risky occupation]. / Riskli bir meslek olarak profesyonel uzun yol süruocolerinde legionella pneumophila seropozitifldginin arastirilmasi.

Contaminated water sources, reservoirs and systems such as evaporative condensers of air-conditioners are known to be the main transmission routes of Legionella spp. which are ubiquitous aquatic bacteria. By virtue of this point the aim of this study was to investigate the rate of Legionella pneumophila seropositivity in a profession considered as risky due to the direct and prolonged exposure to air-conditioning and air-circulating systems. For this purpose, in the period of February-August 2004 a total of 79 male subjects (63 were bus drivers and 16 were driver assistants) who were continously travelling to two different route (South part as hot climate and Middle/North parts as cold climate of Turkey) from Denizli province coach station (a province located in internal Aegian where accepted as crossroads), were included to the study. The mean age and mean working duration of bus drivers were 43.0 +/- 1.1 years and 20.0 +/- 1.1 years, respectively, while these values were 22.5 +/- 0.9 years and 4.0 +/- 0.6 years, respectively, for the drivers' assistants. The serum samples collected from the subjects were screened by a commercial indirect immunofluorescence method (Euroimmun, Germany) using L. pneumophila serogrup 1-14 antigens for the presence of specific antibodies. Additionally, air-conditioners' moisture exhaust samples of the busses in which seropositive subjects travelling with have been examined by culture and 5S rRNA gene targeted polymerase chain reaction (PCR) methods, for the presence of Legionella spp. The overall L. pneumophila seropositivity rate was detected as 15.2% (12/79). This rate was 19% (12/63) for bus drivers while all of the drivers' assistants were found seronegative. The seropositivity rate was found statistically higher in the personnel who were travelling to the hot climates (10/36, 27.8%) than those who travel to cold climates (2/43, 4.6%), (p < 0.05). The culture and PCR yielded negative results for Legionella spp. in the exhaust samples collected from the air-conditioners of the busses in which seropositive drivers travel. Our data indicated that long distance bus drivers were chronically exposed to this pathogen and this may be considered as an occupational risk factor for legionellosis especially for drivers who travel to the west and south parts of our country (mean temperature in August 2004: 30-35 degrees C), since the bus air-conditioning and air-circulating systems are active during the travel. Further studies on air spreading of Legionella in intercity buses can reveal how the exposure occurs for bus drivers.